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(269) Epidemiology and outcomes of invasive aspergillosis (IA) among pediatric immunocompromised patients: a 12-year, single center experience.


Authors:

Fatima Al Dhaheri, MBBS – Dr, Boston Childrens Hospital

Rose Lee, MD, MSPH – Infectious Diseases and Medical Microbiology Fellow, Boston Children's Hospital

Mari Nakamura, MD, MPH – Assistant Professor, Boston Children's Hospital, Harvard medical school

Francisco Marty, MD – Associate Professor, Brigham and Women's Hospital


Co-Authors:

Presenting Author: Fatima Al Dhaheri, MBBS – Infectious Diseases fellow, Boston Childrens Hospital, Harvard medical school
Co-Author: Rose Lee, MD, MSPH – Infectious Diseases and Medical Microbiology Fellow, Boston Children's Hospital
Co-Author: Mari Nakamura, MD, MPH – Assistant Professor, Boston Children's Hospital, Harvard medical school
Co-Author: Francisco Marty, MD – Associate Professor, Brigham and Women's Hospital

Abstract:

Background :

IA remains a leading cause of morbidity and mortality in immunocompromised children, and our understanding regarding epidemiology and outcomes of IA are limited and based on adult studies.  


Methods : We conducted a retrospective evaluation of cases of proven or probable IA according to the 2008 EORTC/MSG criteria cared for at Boston Children’s Hospital from 2007 to 2019. We collected data including demographics, clinical characteristics, diagnosis modality, antifungal treatment, and survival. Survival curves over one year were estimated using the Kaplan-Meier method and univariate and multivariate Cox modeling was used to evaluate for risk factors for mortality.


Results :

67 patient cases were identified, 20 (30%) with proven IA and 47 (70%) with probable IA. The mean age at diagnosis was 11.9 years (6months – 28 years). Underlying conditions included hematopoietic-cell transplantation (HCT) in 45%, cancer in 21%, and solid organ transplantation in 18%. Pulmonary IA was the most common (70.1%) presentation. Diagnostic modalities included positive microbiology alone (18%), fungal PCR alone (1.5%), galactomannan alone (28%), and multiple modalities for the remaining cases (52.5%). 44.8% of patients were neutropenic at diagnosis and 78.5% of patients with malignancies were receiving chemotherapy. Immunosuppressive drugs included glucocorticoids in 34.3%, calcineurin inhibitors in 31.3%, and IMDH inhibitors in 25.3%. Voriconazole was the most common treatment used (72%). 22 (33%) deaths occurred in the cohort attributable to IA (6 of which underwent autopsies and 4 had histopathological confirmation) Most deaths occurred in the BMT patients (15 patients, 45% of deaths). The 6 week mortality was 18% while the 12 week mortality was 25.4%. No antifungal or immunosuppressive regimen had a statistically significant impact on mortality.


Conclusion :

We demonstrate in our > 10 year retrospective cohort analysis of immunocompromised hosts that IA is associated with 49% all-cause mortality with particular impact on the BMT population. No protective nor harmful association was also noted with a particular antifungal or immunosuppressive regimen. 





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